The U.S. public health system and primary healthcare providers must be prepared to address various biological agents, including pathogens that are rarely seen in the United States. High-priority agents include organisms that pose a risk to national security because they:

• can be easily disseminated or transmitted from person to person;
• result in high mortality rates and have the potential for major public health impact;
• might cause public panic and social disruption;
• require special action for public health preparedness.

Category A Diseases/Agents

• Anthrax
• Botulism
• Plague
• Smallpox
• Tularemia
• Viral hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and arenaviruses

Category B Diseases/Agents

• Are moderately easy to disseminate
• Result in moderate morbidity rates and low mortality rates
• Difficult to detect under current methods

Category B Biological Agents include:

• Brucellosis Epsilon Toxin
• Food Safety Threats (i.e. Salmonella)
• Glanders
• Meliodosis
• Psittacosis
• Q Fever
• Ricin
• Staphylococcal B
• Typhus Fever
• Vibrio Cholera
• Viral Encephalitis
• Water Safety Threats

Enhancing Bioterrorism Preparedness and Response Post September 11
Interim actions for Medical & Public Health Community

HOSPITALS

• Review all relevant disaster response plans and assure appropriately designated staff are familiar with their content and strategies.
  
• Establish internal and external lines of communication. Assure that medical staff are aware of the need to report suspicious cases of illnesses to public health authorities, and are familiar with who these authorities are. Have in place dedicated staff, phones and fax machines to support rapid reporting.
  
• Hospital leaders should establish collaborative strategies for communicating with neighboring hospitals, civic leaders, and public health authorities.
  
• Quantify pharmaceutical and antibiotic supplies, both at central and satellite facilities. Routinely update this list.
  
• Assess routine staffing and emergency call-up plans and assure that these are supported with communication and transportation strategies. Update the roster of essential personnel.
  
• Maintain ongoing primary and redundant communication systems.
  
• Assure that appropriate health care professionals (e.g., emergency dept and urgent care dept personnel, infection control and infectious diseases professionals) are aware of the importance of reporting unusual disease presentations, disease clusters and atypical patterns of hospital use and know the mechanisms to do reporting.

Other Resources for Hospitals
Smallpox: What Every Clinician Should Know (online training)

PHYSICIANS

• Develop an increased awareness of the ongoing threat of bioterrorism.
  
• Become familiar with and develop a working knowledge of the most likely and dangerous pathogens as viewed by the CDC (Note link sites and fact sheets below)
  
• Become familiar with relevant lines of communication, and important and emergency phone numbers (hospital epidemiologist, state epidemiologist, local health department (may be city or county), and the CDC emergency number (see below)
  
• Monitor disease patterns and patient volumes in clinics and offices. Immediately notify the appropriate authorities if you suspect an unusual event or need medical guidance.
  
• Patients can also be referred to the CDC public inquiry phone number (see CDC numbers below) regarding information about infectious diseases and bioterrorism preparedness response efforts. Have referral numbers for mental health and support services as needed.
  
• The Center is aware that a number of physicians have received requests for prescriptions for antibiotics to be used in the event of a bioterrorist attack. It should be known that Centers for Disease Control maintains a National Pharmaceutical Stockpile of large quantities of antibiotics and vaccines that could be distributed in the event of an epidemic brought on by an act of bioterrorism.

PUBLIC HEALTH

• Local and state public health agencies should collectively review bioterrorism response plans. Attention should be given to assuring the integration of response plans, including mechanisms for sharing resources and personnel as needed.
  
• Syndromic surveillance procedures should be put in place to monitor and detect atypical disease presentations and clusters. Both passive and active surveillance systems should be examined and refined across public health agencies and with reporting sources.
  
• Establish and maintain capacity to accept reports of unusual disease events twenty-four hours a day, seven days a week. Assure systems of continual, bi-directional communication between public health agencies and hospitals under their purview.
  
• Appropriately trained disease investigation staff should be available for immediate mobilization and deployment as needed. Staffing levels should be reviewed and plans put in place to determine non-urgent public health functions and clinics should it be necessary to pull additional clinical and field staff for urgent investigation activities.
  
• Assess communication systems, including procedures for immediately contacting public health and political leaders. Systems should be assessed to assure that appropriate authorities could be contacted at the outset of an emergency. Mechanisms for maintaining ongoing communication, including pagers, cell phones and wireless email systems, should be assessed and tested. All staff that provide on-call and disease investigation response and decision-making should be adequately resourced for 24/7 communication.
  
• Hold regular meetings with all appropriate government and non-governments agencies and organizations to continually review and refine plans.

INTERNET RESOURCES

LOCAL & STATE
WWW.BIOTERRORISM.SLU.EDU (Centers for the study of Bioterrorism & Emerging Infections)
www.dhss.state.mos.us (Missouri dept. of Health and Senior Services)
http://www.homelandsecurity.state.mo.us/ (Missouri Department of Homeland Security)
http://www.sema.state.mo.us/semapage.htm (Missouri State Emergency Managmeent System)

GOVERNMENT
www.cdc.gov (Center for Disease and Prevention)
www.bt.cdc.gov (CDC's bioterrorism pages)
www.smallpox.gov (United States Department of Health & Human Services)
www.fema.gov (Federal Emergency Management Agency)
www.fbi.gov (Federal Bureau of Investigation)
www.smallpox.army.mil (Military Vaccine Program)

PROFESSIONAL
www.cidrap.umm.edu (Center for Infectious Disease Research & Policy)
www.apic.org (Association for Professionals in Infection Control and Epidemiology)
www.naccho.org/PROJECT63.cfm (National Association of County and City Health Officials)
www.apha.org (American Public Health Association)
www.naemsp.org (National Association of EMS Physicians)
www.emergency.com (Crisis Conflict and Emergency Service News, Analysis & Reference)
http://www.hopkins-biodefense.org/ (Johns Hopkins Center for Civilian Biodefense Strategies)